The present text, Progress in bioethics is part of the Basic bioethics series and is a compilation of papers relating to progressive bioethics in America. The collection of works, edited together by Jonathan Moreno and Sam Berger, are squarely rooted in recent American history and in several instances are framed by political debates over stem cell research and abortion. A central concern, certainly in the early part of the text, relates to what the authors believe is the strengthening hold that religious conservatism has within these discussions at the highest political level.

The book is divided into five parts, the first of which is designated "Bioethics as politics" and comprises two papers. In Chapter 1 Berger and Moreno introduce the term "progressive bioethics" and provide an historical account of this. Chapter 2 (Richard Lempert) discusses progressive bioethics, largely against the backdrop of of human embryonic stem cell research (hESCR).

In setting out their perspective Berger and Moreno designate critical optimism, human dignity, moral transparency, and ethical practicality as "the four major values of progressive bioethics" (p. 18) stating that those who share these values should "[...] take a more active role in the public and political debate around these issues." (p.21). Thus they make their call for an increase in political influence by what they define as the progressive bioethics movement.

In part II, "Bioethics as progressive", the reader is presented with three papers which offer critiques of the political climate surrounding bioethics and particularly the President's Council of Bioethics under President Bush. Chapter 3 (R. Alto Charo) is the first of these and begins with reflections on the debate over stem cells, arguing that prohibition under the Council has shifted the burden of proof "so that a presumption of freedom to do research is replaced with a presumption that research may be banned even in the absence of concrete harms to actual persons" (p.48). Such concerns over conservative bioethics are continued by Kathryn Hinsch in Chapter 4 in which she discusses the influence on public opinion and policy generated by conservative organizations. She surmises that in strategically setting out a position on a range of bioethical issues such organizations are "positioned perfectly to frame the discussions, define the vocabulary, and, ultimately forge public policy on bioethical issues." (p. 68). The remainder of the chapter consists largely of a potted history and analysis of key conservative bioethics centers and organizations before concluding that

"If progressives continue on the present course of tackling issues one by one, they will lose the opportunity to make a difference in shaping the future of bioethics in the United States. Only once an overarching moral framework has been established, and channels for dissemination of these views has been built, will progressives be able to compete effectively with the conservative agenda." (p. 88).

The final chapter of the section comes from Laurie Zoloth and again focuses on the Presidents Council of Bioethics under President Bush, although the focus in this chapter is on critiquing the conservative bioethics perspective, with particularly commentary on the work of Leon Kass.

Part III of the book goes under the heading of "The sociology of political bioethics" and consists of a series of papers which concern themselves with the role of bioethics within a culture of increasing (bio)medicalization (Paul Root Wolpe), the tension between bioethics and religion (John H. Evans), and a specific consideration of National Bioethics Commissions (Eric M. Meslin). These present a departure from the campaigning of the earlier sections, particularly the papers by Wolpe and Meslin who each provide discussion of specific areas rather than more general advocacy for policy influence as was the case earlier in the book.

Part IV, "Conflicting views of biotechnology", consists of two papers that take a distinctly socio-political approach. Chapter 9 sees James H. Hughes demarcate existing bio-political movements and positions whilst Marcy Darnovsky discusses the politics of science in the Bush era. Whilst both offer different analyses there is extensive repetition of the stem cell debate and the Presidents Council.

The final part of the book, "Progress beyond politics?", comprises four papers that mark a refreshing change in the tone and content of the book, taking as they do applied examples of a progressive bioethics. Arthur L. Caplan presents a short piece questioning whether bioethics can transcend ideology whilst Michael Rugnetta in Chapter 12 offers a discussion of conscience clauses which allow health-care workers to refuse to participate in certain health-care practices (principally abortion) on moral or religious grounds. The penultimate chapter comes from Daniel Callahan who discusses reformation of health care and arguments relating to market systems and universal care. The book concludes with a paper by William F. May who discusses the field of bioethics and whether there can be a role for religion in bioethics and a "common ground".

A theme which runs throughout much of the text, and which is exemplified in the quote taken from Hinsch, is the purported need for a consistent voice from the progressive bioethics movement. Yet, as the contributions in the remainder of the text demonstrate, there is a plurality to the argumentation presented by those who they wish to demarcate as "progressive", and for this reader such a plurality is to be welcomed. Not only is this in-keeping with the nuances and complexity of the issues with which those working in the field of bioethics engage, it also prevents the creation of a false dichotomy of opposing views which such a consensus approach creates potential for.

The collection itself also suffers from a dichotomous persona in some respects. On the one hand there is the portion of the book which is largely calling for political and policy engagement by the progressive bioethics community, and on the other there are the papers (which principally can be found in the final part of the book) applying progressive principles to discrete concerns. At times there is also extensive revision and rehearsal of the same information and concerns, particularly surrounding the role of the President's Council of Bioethics and the debate around stem cell research during the time of President Bush. Whilst such discussions may be of interest to political historians the amount of repetition felt unnecessary at times.

Having expressed these concerns the book does provide an interesting insight into the divisions which exist within American bioethics, and particularly the politically charged climate that the discipline finds itself. Such an analysis may well be useful for those interested in the political nature of policy-making on ethical issues, but for those who may be seeking more applied analyses the text offers limited, albeit interesting, content.

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